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Problem/Solution: Turkey Wattle

You’ve religiously applied lotion to your neck since the Reagan era. Then why the turkey wattle? Because neck skin shows age more quickly. As author Nora Ephron wrote: “Our faces are lies and our necks are the truth.”

The Problem

The problem can be summed up in one word: gravity.

As Dr. Bradley Bloom, dermatologist at Skin Laser and Surgery Specialists in New York and New Jersey, explains, the underlying anatomy of the neck — specifically the paired muscle platysma — is extremely thin. “As you age, gravity causes laxity from the lower face to be transmitted down to the platysma where it becomes apparent quickly. Also, with gravity and aging, the ligaments that attach the platysma muscles to the underlying structures of the neck loosen, which gives the appearance of vertical neck bands,” he says.

Add to that, “as we age, our skin loses elasticity, stops producing collagen (in large quantities), loses subcutaneous fat, and suffers environmental damage, usually in the form of sun damage,” says Dr. Steven M. Levine, Clinical Assistant Professor of Surgery at Hofstra Northwell School of Medicine Medical School at Hofstra University, New York. Dr. Bloom notes that even poor posture and “tech neck,” the act of putting your chin to your chest as you type on your phone, can lead to neck drooping.

If your neck hasn’t started to sag, preventive measures boil down to lifestyle changes. “As with all aging, a healthy diet and exercise make everything look better,” Dr. Bloom says. “You want to avoid significant weight gain, as this can cause fat to accumulate in the neck, which helps gravity cause the neck skin to sag.” He stresses that good posture can be learned, and making it a part of your daily life can help you avoid tech neck — as will putting down your phone. But if giving up your phone is a bridge too far, try one of these solutions.

The Solution #1: Topical Care

“One reason we see age more prominently in the neck than in the face is that people are more aware of maintaining their face,” says Dr. Levine. He uses sunscreen as an example. “It’s the most effective anti-aging substance we have. Most people don’t use it. And for those who do, they don’t apply it often enough and usually not beyond their face.”

And because gravity can’t be avoided, your first step in dealing with a droopy neck is simply taking care of that stretch of skin. While so-called neck-firming creams provide benefits, Dr. Bloom is quick to note that these creams don’t exactly firm the neck. “Rather, they ensure the skin is healthy and protected,” he says — which, as Dr. Levine says, is not to be ignored (though your expectations of a neck lift in a jar should be kept in check).

Dr. Bloom suggests investing in a superior sunscreen (try: EltaMD UV Clear Broad-Spectrum SPF 46); since the neck skin is thin, protecting it against premature loss of collagen due to sun damage is a must. Then, add a twice-daily application of a topical treatment that includes retinol (try: PCA Skin Perfecting Neck & Décolleté) to help increase cell turnover and stimulate collagen production, or one that contains growth factors, antioxidants, and peptides (try: SkinMedica TNS Essential Serum) to keep skin hydrated while fighting sag-magnifying crepiness.

The Solution #2: In-Office Treatments

Integrating sunscreen as well as targeted neck creams and serums into your daily beauty regimen benefits the neck greatly, but if your neck still wiggles a little too much for your liking, chin up! An in-office neck treatment can help.

ThermiTight: Thisnon-surgical, minimally invasive treatment uses a tiny probe to deliver radiofrequency (RF) energy to depths beneath the skin’s surface. This energy improves skin laxity and smooths texture, as well as melts fat all in a single treatment, which makes its hefty $4,500 to $6,500 price tag slightly more palatable.

“For neck laxity, this device currently gives the best results in the least number of treatments for people who are unwilling to undergo surgery,” Dr. Bloom says. The doctor uses local anesthesia, and patients generally see results within a month, though maximum results truly become apparent when collagen remodeling is complete, around the four- to six-month mark. What’s more: This truly is a one-and-done treatment, as the effects are long lasting. “It’s your own body’s collagen and elastic tissues that have been stimulated,” Dr. Bloom says.

Infini: This device delivers high-intensity focused RF energy through an array of microneedles that a dermatologist can manipulate to variable depths, allowing him or her to selectively target multiple layers. Typically priced around $1,500, “the Infini combines the benefits of microneedling with deep heating to stimulate your body’s production of new collagen and elastic tissue,” says Dr. Bloom.

Because the heat is delivered into the deeper layers of the skin, the top layers are protected, making this treatment great for all skin types while nixing visible wounding on the skin’s surface. He recommends three to five treatments, spaced four weeks apart, and reports that results are typically seen by the third treatment, with maximum results occurring four to six months after the initial treatment.

Non-Surgical Neck Contouring: Much like injecting Botox into deep-seated wrinkles to relax the surrounding muscles, injections of neuromodulators (Botox, Xeomin, and Dysport) into neck muscles can help improve the contour of the neck. However, to maintain the effects, you’ll need to repeat every three months. “Remember, the neck muscles are much larger muscles than the facial muscles those medicines are usually used to treat,” Dr. Levine notes.

The Solution #3: Surgery

At an average of $8,500, a neck lift can be a truly transformative procedure for a droopy neck. “Without question, a neck lift is the gold standard. No non-surgical solution can compare in efficacy or longevity to what a neck lift can deliver,” Dr. Levine says.

When pursuing surgery, you should do your homework on your surgeon first and foremost. “The average plastic surgeon performs very few of these procedures per year, mainly because the majority of neck lifts are concentrated among a handful of surgeons. So, in addition to making sure your surgeon is a board-certified plastic surgeon, make sure that her or she performs this type of surgery regularly,” Dr. Levine says.

From there, you’ll want to meet with your chosen doctor at least twice before proceeding with surgery. “[You want to make sure the doctor] has thoroughly answered all of your questions and that you’re comfortable moving forward,” he says. Then, its time for the neck lift, which can be accomplished in one of several ways.

“Typically, incisions are made behind the ear, the neck muscles are tightened from the sides, and extra skin is removed and naturally redraped,” Dr. Levine says. “Sometimes an additional incision is made under the chin to access the midline neck muscles … to minimize the appearance of neck bands.” Surgery takes anywhere from 90 minutes to 4 hours, resulting in very little bruising and swelling. Downtime is minimal — usually a week — and results can last well beyond any other treatment.

Dr. Levine puts it this way: “In a well-executed neck lift, your neck should look better in 10 years than it did before surgery.”

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